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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317005468
Report Date: 11/06/2025
Date Signed: 11/06/2025 12:19:00 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250912093923
FACILITY NAME:BROOKDALE AUBURNFACILITY NUMBER:
317005468
ADMINISTRATOR:MALISSA ACUNAFACILITY TYPE:
740
ADDRESS:11550 EDUCATION STTELEPHONE:
(530) 888-8847
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:110CENSUS: 94DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Malissa Acuna, Executive DirectorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff do not ensure that residents are provided adequately supervised, resulting in resident sustaining an injury
Staff do not ensure that residents' incontinence needs are met
Staff do not assist residents with showering
INVESTIGATION FINDINGS:
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Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Executive Director Malissa Acuna to deliver findings for the above complaint allegation.

During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

*** Report continued on 9099-C***
Unfounded
Estimated Days of Completion: 5
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20250912093923
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BROOKDALE AUBURN
FACILITY NUMBER: 317005468
VISIT DATE: 11/06/2025
NARRATIVE
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Staff do not ensure that residents are provided adequately supervised, resulting in resident sustaining an injury

Interviews conducted indicated that resident R1 was supervised during shower and no injuries occurred. R1 sustained an skin abrasion after the shower where R1 slid down the wall to the floor to the seated position, no fall occurred. Records reviewed indicated R1 is not a fall risk and did not require hands on showering, only stand by assistance. Therefore, the allegation staff do not ensure that residents are provided adequately supervised, results in resident sustaining an injury unfounded.

Staff do not ensure that residents' incontinence needs are met

Interviews conducted indicated that staff are taking care of incontinence needs of all residents. Interviews with residents indicated that there is no concerns with incontinence care and staff are very helpful. Records reviewed indicated residents have incontinence needs indicated on their service plans which is followed by staff. Service plans are updated as needed or at least every six months. Interviews with residents R2, R3, and R4 indicated that there are no complaints with staff and the incontinence care that is received. Therefore, the allegation staff do not ensure that residents’ incontinence needs are met is unfounded.

Staff do not assist residents with showering

Interviews conducted indicated that staff are assisting with showering needs. Staff will assist a resident with a shower on their day and if a shower is refused, there are protocols in place to help attempt a shower again, like changing face of the staff member or changing the time of day. Sometimes, shower days are changed based on staff schedules which is communicated with residents. Interviews with residents R2, R3, and R4 indicated that there are no complaints with showering. Records reviewed indicated showers are provided and indicated on shower sheets. Showers are documented and skin checks are done to assess resident. Therefore, the allegation staff do not assist residents with showering is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2